Subcutaneous Onlay Laparoscopic Approach for small ventral hernias associated with divarication of rectus abdominis muscle.

Background: Ventral hernias when associated with divarication of rectus abdominis if repaired without concomitant repair of the divarication is plagued by higher rates of recurrences. Out of the many options available for the repair, Subcutaneous Onlay Laparoscopic Approach (SCOLA) with concurrent plication of the divarication is gaining popularity. Methods: All patients with a ventral hernia associated with divarication of recti were included in this prospective study. The calculated sample size was 34 with a confidence level of 95% and a margin of error of 5%. The patient demographics, operative time, intraoperative and postoperative complications, need for post-operative blood transfusion, and the recurrence were recorded. Categorical data were compared using Student's t-test, whereas chi-square test was used to compare the nominal variables between the two groups. A P-value of <0.05 was considered to be statistically significant. Results: Thirty-six patients were analysed for the study with a mean age of 43.40 years. A total of 55.55% patients were female. Twelve patients had co-morbidities. Umbilical hernia was the most common hernia. The mean size of the hernial defect was 3.67 cm, and the mean operative time was 156.66 min (±31.02 min). The first 15 cases took longer time for the surgery (mean operative time 183.53 min [±19.73 min]). No intraoperative complications were recorded, except for one patient in whom we encountered an excessive bleeding but was tackled with harmonic scalpel. Eight patients (22.2%) had complications with Seroma formation being the commonest. Conclusion: SCOLA is feasible and advantageous because of faster recovery and minimal complication and recurrence rates.